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ILLUSTRATING THE PRACTICE 

OF 

MIDWIFERY, 

DR. THOMAS DENMAN. 









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A SERIES 





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ENGRAVINGS 



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ILLUSTRATING THE 



PRACTICE OF 



BY 

THOMAS DENMAN, M.D. 



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DESCRIPTIONS 



OF 



THE ENGRAVINGS. 



PLATE I. 

The Funis of a Nut.— The Chrysalis of the Phalcena Atlas. — The Eggs of the Cuttle Fish. 

I have joined these three subjects in one plate, on account of their resemblance, though they 
are taken from such different parts of the creation. 

In the representation of the nut, attention is chiefly paid to the funis, which is mentioned by 
Linnaeus, and probably by many other writers. As the apex of the kernel is by this funis 
bound to the broad end of the shell, the shell to the husk, or foliaceous cup, and this again by 
a twig- to the tree, the whole manner in which nourishment is conveyed to the kernel appears. 
The coats of the kernel likewise resemble the membranes of the ovum in viviparous animals ; 
and the flocculent lining of the shell, the membrane formed, after conception, over the internal 
surface of the uterus. Mr. Miller, who made this drawing, thinks that many seeds have a 
similar apparatus. 

In some shells, the apricot for instance, there is no lining to the shell, or connexion between 
it and the kernel. In such, the shells being covered with fruit, or a husk, are more porous, and 
the nourishment penetrating the cavity in the form of a dew, is absorbed by the kernel. — See 
Amcenitat. Academ. vol. iv. 

The chrysalis of this moth was plucked from the tree on which it hung, on an island in the 
Straits of Malacca, by my worthy friend Thomas Liell, Esq., and on the following day a large 
and beautiful moth escaped. 

I do not know that there is anything peculiar in this chrysalis ; but the largeness of the 
size serves to shew distinctly the beautiful arrangement of that substance which is spread like 
net work over the surface of the chrysalis, and which, being concentrated at the upper end into 
one cord, is fixed to a twig of a tree as a place of security. — See Meriaiis Surinam Insects, 
pi. lii. — Amcenitat. Academ. vol. iv. Bombyx. 

The eggs of the cuttle fish, which in their form and size resemble a small grape, are fastened 
in clusters by an animal substance to sea-weed, in a place suited to the state of the fish when 
it escapes from the egg. Gesner, in his account of the sepia, has quoted the reason assigned 
by Aristotle for these eggs being collected into clusters : — " that they may be conveniently im- 
bued with that viscous fluid ejected by the male, by which they are to be nourished and in- 
creased." Gesner also speaks of their exclusion from the egg in these terms : — " Mox ova 
edita crassitudinem acinorum uvse minorum intra diem decimum quintum capiunt, quibus 
abruptis sepiolse excluduntur ; quae, (si quis prius, prole jam perfecta, absciderint ovi membra- 
nam,) stercusculum mittunt, suumque prse metu colorem immutant ex candicante in rubius- 
culum.' See Amcenitat. Academ. vol. i. See also Aldrovandus, Charlton, and Gesner. 



(4 ) 

PLATE II. 

A Display of the Internal Parts of a Frog, with the Ovaria. 
Before the contents of the ovaria are deposited, those in a frog are so large, and so much 
expanded, that they hide the uterus and origin of the ovaria, and almost all the viscera of the 
abdomen. For this reason Roesel thought it necessary to give two drawings for the explana- 
tion of this subject ; the first, to represent the ovaria, and the second, the parts of generation. 
But, by turning aside the left ovarium, every thing is brought to view without any derange- 
ment, and as clear a representation is made of the whole as the nature of the subject allows, 
or seems to require. 

PLATE III. 

A Section of a Hen, showing the Ovarium, with an Egg perfected in the Infuudibulum. 

In the ovarium of a hen are contained the primordia of an infinite number of eggs, differing 
in size, and rising towards perfection in regular succession. While these abide in the ovarium, 
they consist of the yelk only, impregnated with the fecundating principle conveyed in the act 
of copulation ; but in their passage through the infundibulum, which has a membranous expan- 
ded orifice fitted for their convenient reception, they collect the white, and other subordinate 
parts. In the lower part of the infundibulum, which by some writers has been distinguished 
as the uterus, thev become invested with the membranes and shell; soon after which thev are 
expelled. 

Harvey has given as good a description of these parts as words can convey ; but a represen- 
tation to the eye was wanting ; and this plate, by the exertion of the artists, is rendered worthy 
of supplying that deficiency. Dr. Graaff has indeed given a delineatiou of the ovarium and 
infundibulum ; but they are taken out of the body, by which means their original position, re- 
lation, and genuine appearances, are lost. 

There is yet wanting a delineation of the daily changes made in the egg during incubation. 
These might be reduced into one view, and then the subject would be nearly complete. 



PLATE IV. 

The Uterus, with the Bladder, of a Ewe. 

This very beautiful drawing represents the form of the uteri of the Pecora, or sixth class of 
animals, according to the system of Lixn\sus ; in which the fundus of the uterus is divided into 
branches or horns, convoluted and terminated in a point. 

In the succeeding plate there is given a specimen of one of the cotyledons of a cow, which is 
an animal of the same class. 



PLATE V. 
A Part of the Uterus of a Cow, with one of the Cotyledons, and a portion of the Membranes. 

Thk changes which take place in the uterus of a doe, after conception, as the softness and 
tumefaction of its substance, the formation of its membranous lining, and the origin and pro- 
gress of the caruncles or glandular eminences in its coruna, to which the cotyledons are after- 
wards fixed, are all particularly described by Harvey. 

The drawing now before us is from these parts in a cow, an animal of the same class, which 
therefore are probably in all respects, except the size both of the caruncles and cotyledons, 
similar to those of the doe. This cotyledon is in part separated and turned from the caruncle, 
by which means the texture of both is more clearly seen, and additional beauty given to the plate. 



( 5 ) 
PLATE VI. 

Three Human Abortions, one of which contains Twins. 

If delineations were to be made of every variety observed in abortions, there would be no 
bounds to the work. Yet in every collection there must be some examples, that we may be 
able to distinguish the different parts of which an ovum is composed, the proportions which 
they bear to each other at different periods of pregnancy, and sometimes the part of the pro- 
cess of utero-gestation which failed. It must however be allowed, that the generality of these 
things are preserved for their beauty, or as matters of curiosity rather than of use. I suspect, 
nevertheless, that there are some appearances, besides the vesicula umbilicalis, not yet perfectly 
understood, and therefore recommend the whole subject as worthy of being reviewed by some 
anatomist, who has time and opportunities of examining it with accuracy. The figure which 
contains twins is in itself of rather more value, as it is the first of the kind which has been 
delineated. 



PLATE VII. 



The Uterus, with the Ovum contained in it, of a Woman who died about the seventh week of her 

Pregnancy. 

This drawing was taken under the inspection of the late Dr. William Hunter and Dr. Un- 
derwood, from a woman who died in consequence of a uterine hemorrhage, which came on 
about the seventh week of her pregnancy, and proved fatal before the ovum could be expelled. 
The os uteri was sufficiently opened, and all the parts of the ovum loosened from the uterus, 
except a small portion at {he fundus, the attachment of which remained very firm, and had a 
scirrhous feel and appearance. The common means had been used to abate the hemorrhage, 
and to favour the exclusion of the ovum, but without effect ; for the patient died on the third 
day from the first symptoms of abortion ; the prognostic, founded on the general event of such 
cases, not giving reason to apprehend danger. 

The short lines, which pass from the uterus to the ovum, shew very distinctly the mannei 
of their connexion, and the part which was found adhering when the body was opened. 



PLATE VIII. 

A Human Ovum, about the third month of Pregnancy. 

This ovum is rather larger than might be expected from the date, and more perfect than 
those usually are which are expelled in consequence of the common causes of abortion. No 
other art was used in preparing it than by soaking it in water, to cleanse it from the adhering 
blood. The artist who made the drawing was a German, whose name was Nall. He was so 
struck with the beauty of the preparation, that he never was satisfied with his work, and took 
uncommon pains to finish it. 

Besides the two proper membranes of the ovum, there is preserved a large portion of that 
membranous production of the uterus, the formation of which Harvey has so well described ; 
which many writers have denominated the false or spongy chorion ; Ruysch, from its appear- 
ance, the membrana villosa, ilium placenta partem obducens, qua uterum respicit ; Bianchi, the 
placento vascularis cortex ad totum ovi ambitum ; Hunter, suspecting it to be a lamella cast off 
from the uterus after every conception, decidua ; and from its duplicature, or transit over the 
ovum, which he discovered, decidua refexa ; and which, from its office, I have ventured to 
call the connecting membrane of the ovum. 



( 6 ) 
PLATE IX. 

A Morbid Human Ovum. 

The circumstances chiefly deserving attention in this plate are, the small size of the embryo 
compared with that of the placenta, the dropsical state of the funis umbilicalis, and the change 
which has taken place on the internal surface of the placenta, which is rising into eminences, 
and has assumed such an appearance as if it would have been formed into tubercles of hyda- 
tids, in the manner suggested by Ruysch, and of which he has given several drawings. 

It appears that this embryo must have been blighted in the very early part of pregnancy, 
though it has no marks of decay. But the placenta adhered, increased in its size, and remained 
in the uterus to the end of the ninth month, and was then expelled without much pain or di- 
ficulty. When brought to me it was supposed to be a mole, and seemed like a mass of flesh 
without any particular organization ; but when carefully examined, was found to be an ovum 
with the appearances so well represented in this plate. 



PLATE X. 

The Uterus, containing the Child of a Woman who died in the Act of Parturition. 

The preparation, from which this drawing was taken, has not been disturbed in any other 
way than was absolutely necessary to free it from the parts to which it was connected ; but as 
it has been preserved in spirits, the outline of the limb and body of the child is rendered some- 
what hard. It may however be considered as a just and perfect view of the situation of the 
foetus in utero at the time of birth ; and though, perhaps, no two children were ever found ex- 
actly in the same position, there is one which may be called the most natural, because its ge- 
neral habitudes are most frequent. This now exhibited corresponds so punctually with 
that described with such unrivalled elegance by Harvey, that his description might be almost 
suspected to have been taken from the same preparation. 



PLATE XI. 

Rupture of the Uterus. 

The person, from whom this drawing was taken, died suddenly in the act of parturition. I 
saw her a very short time before her death ; and, no attempts having been made to extract the 
child, all the parts are exhibited precisely in the undisturbed state in which they appeared on 
making a crucial incision through the integuments of the abdomen. 

The case was an example of the spontaneous rupture of the uterus at the posterior part, op- 
posite the projection of the sacrum. The body of the child escaped into the cavity of the ab- 
domen, the head remaining locked in the pelvis. The fundus and anterior part of the uterus, 
not being diseased or injured, had contracted properly after the exclusion of the child. The 
casual expansion of the right fallopian tube with its fimbria upon the body of the child ex- 
plains the relative situation of the parts, and gives additional beauty to the plate. 

Many cases of the rupture of the uterus are recorded by different writers, especially by Bo- 
netus in his Sepulchretum, and by La Motte ; but I believe no just engraving of the subject has 
been published. There is yet wanting a representation of a rupture at the anterior part of the 
uterus ; which sometimes happens, though far less frequently than at the posterior part. For 
the completion of the subject it would also be necessary to delineate some of the varieties, to 
determine the precise part which is most commonly ruptured, together with the state of the 
uterus at the ruptured part. But of the rupture of the uterus the instances are so rare, that 
what remains to be done must be finished by the labours of different anatomists and practitioners. 



(7) 
PLATE XII. 

Inversion of the Uterus. 

Of the inversion of the uterus many accounts have been published, particularly by Ruysch, 
who has also given a drawing of it soon after the accident ; but this is not sufficiently exact to 
convey much information. There is likewise in that very correct and splendid work of the late 
Dr. William Hunter, the Anatomia Uteri Humani Gravidi, a plate, which represents the state 
of the surface of the uterus, immediately after its inversion. 

I was called to the patient, from whom this drawing was afterwards taken, soon after her 
delivery, when she was supposed to be in extreme danger from hemorrhage. I very impru- 
dently neglected to take an examination per vaginum, so that the inversion was not discovered 
till near twenty-four hours after the accident ; when the repeated attempts I made, with all the 
address of which I was master, and all the force I dared to exert, failed to reduce it. The 
uterus continued inverted, but the patient survived, and lived several months ; though she was, 
for the remainder of her life, subject to profuse uterine discharges, by which she was at length 
exhausted. I have, however, seen several instances of women, with the uterus inverted, living 
for many years in tolerable health. In this plate the posterior part of the vagina is laid open : 
the uterus seems to be diminished in its size, and the ovaria to be somewhat enlarged. The 
altered position and direction of the fallopian tubes is well represented, and by these all the 
other parts are explained. The inverted surfaces of the uterus, though lying in contact, had 
not adhered. 



PLATE XIII. 



An Extra-uterine Fwtus contained in its Sack, the anterior Part of which is removed. 

Of this case, which was communicated to me by Professor Hamilton of Glasgow, the account 
is imperfect ; but the fact is indisputable, and the drawing a faithful representation of the po- 
sition and state of the child when the sack was opened, after the death of the patient. 

The woman, after several miscarriages, became pregnant ; the motion of the child was dis^ 
tinctly felt ; at the end of nine months she had the symptoms of labour, which after a certain 
time ceased ; there was no evacuation of any kind from the uterus, but the abdomen gradually 
lessened, though it did not return to its natural size. Her husband dying, she married again ; 
but though she menstruated regularly, she was never afterwards with child. From the con- 
ception of the extra-uterine foetus, she lived thirty-two years in good health, nor was her death 
occasioned, directly or indirectly, by that circumstance. 

The foetus, slightly covered with calcareous matter, was included in a globular sack, which 
adhered by a small part of its surface to the left side of the abdomen. Whether the sack was 
formed by the gradual distention of an original part, or was a new substance ; whether the ex- 
tra-uterine state happened from a defect of the ovarium, or from a rupture of the fallopian tube, 
or of the uterus ; or at what period of pregnancy the circumstance occurred, I am not able to 
give any account. 

The plate shews the position of the child, and the degree of change it had undergone, so 
plainly as to require no farther explanation. The child weighed seven pounds. There were 
no remains of the placenta, and only about six inches of the funis. 

In a very old painting in my possession there is a view of the rupture of the fallopian tube 
about the sixth month of pregnancy. This, with many observations found in different authors, 
might be considered as a presumptive proof of a general opinion, that the foetus commonly 
escaped from that part into the cavity of the abdomen. 

The late Dr. William Hunter, I believe, first observed, though the foetus be extra-uterine, 
that the uterus undergoes those peculiar changes which render it fit for the reception of the ovum. 



(8) 

PLATE XIV. 

An Excrescence from the Fundus of the Uterus, ivith an Inversion of the Uterus. 

My very much esteemed friend Mr. Hamilton, professor of anatomy at Glasgow, inspected 
the body from which this drawing was taken. The woman had laboured under the disease 
about three years ; but she had concealed it. The tumor became so large in the vagina, as to 
occasion pains like those of labour, but was at length excluded through the external parts. 
Mr. Hamilton then saw her for the first time, but she was so exhausted, that she died in the 
course of a few hours. 

On the examination of the parts after death, the excresence was found to spring from the 
fundus of the uterus, which was completely inverted, and dragged through the os uteri into the 
vagina. The excresence is seen adhering; and the part where the uterus terminates and the 
excrescence begins, may be readily distinguished. The texture of the excrescence was soft and 
spongy; it measured nine inches in length, twelve in circumference, and weighed one pound 
and four ounces. 



PLATE XV. 

A Twin Placenta with the Membranes. 

Aftkr a slight injection of this Placenta, the membranes were distended with horse-hair, 
and when dried, the subject was placed before the artist. The drawing is therefore somewhat 
formal, not admitting of so much elegance, either in the design or execution, as is observable 
in some of the foregoing prints. But the partition of the membranes into chambers for the ac- 
commodation of the two children is preserved distinctly, and that is the great object of this plate. 

I do not know, or recollect, that any engravings have hitherto been made or published of Ova, 
in which there were two, three, or more children, either in early pregnancy, or at the full period 
of utero-gestation. I therefore recommend this whole subject, in which there may be some 
peculiarities, and certainly are many varieties, to those who may meet with opportunities of 
investigating it, as entirely new, and as affording them room for acquiring reputation, by at- 
tending to a very useful and curious part of natural history. 



PLATE XVI. 

A Poli/pus of the Uterus. 

This plate is engraved from a painting of a preparation in the Museum of the late Dr. Hun- 
tfr. It represents " the uterus and vagina slit open to nearly their whole length, showing a 
polypus larger than a child's head at the time of birth. This hangs from the fundus of the ute- 
rus, by a peduncle as thick as one's finger, and more than an inch in length. 

Several attempts were made to pass a ligature round the stem of this polypus, but without 
success, chiefly on account of its size. Had an attempt been sooner made, there would pro- 
bably have been less difficulty. 

A. The peduncle, — B. The polypus. 



PLATE XVII. 

A Polypus, ivith an Inversion of the Uterus. 

This plate is also engraved from a painting of another prepraration in the same Museum 
In this " the uterus is shown inverted by a large polypus, growing without any stem, from the 
fundus of the uterus, which is dragged low down in the vagina. The ligature (which remains) 
was passed and fixed, as it almost necessarily must, upon the inverted part of the uterus. The 
patient died on the fourth or fifth day after the operation. It is remarkable that the uterus 
was cut to a considerable depth by the ligature, before her death. 

A. The ligature as it was fixed. — B. The origin of thu po/ypus. — C. The lower part of the 
yolypus.